Healthcare Provider Details

I. General information

NPI: 1538084074
Provider Name (Legal Business Name): MRS. JESSICA LAUREN PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALNUT LN STE 101
NORTH AUGUSTA SC
29860-8684
US

IV. Provider business mailing address

104 WALNUT LN STE 101
NORTH AUGUSTA SC
29860-8684
US

V. Phone/Fax

Practice location:
  • Phone: 803-599-7680
  • Fax:
Mailing address:
  • Phone: 803-599-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP005530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: